The holder whose full name is DETAMORE, DAVID LEONARD,come from SOUTH BEND IN,hold the CSR-Dentist license(NO.12005106B) which status is Expired.
| Name | DETAMORE, DAVID LEONARD |
|---|---|
| License Number | 12005106B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | SOUTH BEND |
| State | IN |